Enlarged Prostate Treatment
Prostate Artery Embolization (PAE)
Most treatments for an enlarged prostate work from the inside, reaching the prostate through the urethra. PAE takes an entirely different route: it reaches the prostate through the bloodstream, reducing the blood supply that feeds the enlarged tissue so the gland shrinks over the following weeks. Nothing passes through the urethra, and for many men sexual function is preserved. Texas Regional Urology offers PAE for men seeking relief from enlarged prostate symptoms, with evaluation and follow-up at our offices in The Woodlands, Tomball, and Kingwood.
How PAE Works
What Is Prostate Artery Embolization?
An enlarged prostate, like any growing tissue, depends on its blood supply. PAE reduces that supply deliberately.
A thin catheter is inserted through a small puncture in the wrist or upper thigh and guided through the arteries to the vessels feeding the prostate. Imaging confirms the position. Tiny spheres — roughly the size of grains of sand — are then released into those vessels, where they lodge and restrict blood flow to the prostate.
Deprived of part of its supply, the prostate gradually shrinks over the following weeks and months, easing the pressure on the urethra. Symptoms typically begin improving within a few weeks, with continued improvement for several months.
What makes PAE distinct among BPH treatments is what it avoids. No instrument passes through the urethra. No prostate tissue is cut, heated, or removed. There's no incision beyond a puncture a few millimetres across. For men who want to avoid surgery, or who can't safely have it, that matters.
Compare with the other options: UroLift, Rezum, and TURP.
A thin catheter is inserted through a small puncture in the wrist or upper thigh and guided through the arteries to the vessels feeding the prostate. Imaging confirms the position. Tiny spheres — roughly the size of grains of sand — are then released into those vessels, where they lodge and restrict blood flow to the prostate.
Deprived of part of its supply, the prostate gradually shrinks over the following weeks and months, easing the pressure on the urethra. Symptoms typically begin improving within a few weeks, with continued improvement for several months.
What makes PAE distinct among BPH treatments is what it avoids. No instrument passes through the urethra. No prostate tissue is cut, heated, or removed. There's no incision beyond a puncture a few millimetres across. For men who want to avoid surgery, or who can't safely have it, that matters.
Compare with the other options: UroLift, Rezum, and TURP.
Why Men Choose It
Benefits of PAE
Nothing Enters the Urethra
The entire procedure happens through the bloodstream, avoiding urethral instrumentation altogether.
Sexual Function Is Well Preserved
Retrograde ejaculation is common after TURP and occurs with some other BPH treatments. It's uncommon after PAE, and erectile function is generally preserved.
Suitable for Very Large Prostates
Some minimally invasive treatments have an upper size limit. PAE can treat prostates too large for those options.
An Option When Surgery Isn't
Men with significant heart or lung disease, men on blood thinners that can't be stopped, and men who simply decline surgery may still be candidates.
Local Anesthetic, Not General
PAE is performed under local anesthetic with sedation. You remain awake, and general anesthesia is avoided.
Usually No Catheter
Most men go home without a urinary catheter — unlike several other prostate procedures.
Who Qualifies
Am I A Candidate?
PAE is generally considered for men with moderate to severe urinary symptoms from an enlarged prostate who haven't improved on medication, who don't want to keep taking it, or who want to avoid or can't safely undergo surgery.
It's particularly worth discussing if you have a very large prostate, significant other health problems, or are on anticoagulation that can't be interrupted. Some men in urinary retention are also candidates.
PAE isn't right for everyone. Because it relies on catheter navigation through the pelvic arteries, significant atherosclerosis can make it technically difficult or impossible. Reduced kidney function or a severe contrast allergy may rule it out, since the procedure uses contrast dye and X-ray guidance. Small prostates generally don't respond well. And if your urinary symptoms come from something other than an enlarged prostate — a stricture, bladder dysfunction, or a neurological cause — treating the prostate won't fix them.
Evaluation matters here more than with most procedures. Your urologist will confirm your symptoms are actually from BPH, measure your prostate, assess how well your bladder empties, and check your kidney function before PAE is considered. Learn more about enlarged prostate.
It's particularly worth discussing if you have a very large prostate, significant other health problems, or are on anticoagulation that can't be interrupted. Some men in urinary retention are also candidates.
PAE isn't right for everyone. Because it relies on catheter navigation through the pelvic arteries, significant atherosclerosis can make it technically difficult or impossible. Reduced kidney function or a severe contrast allergy may rule it out, since the procedure uses contrast dye and X-ray guidance. Small prostates generally don't respond well. And if your urinary symptoms come from something other than an enlarged prostate — a stricture, bladder dysfunction, or a neurological cause — treating the prostate won't fix them.
Evaluation matters here more than with most procedures. Your urologist will confirm your symptoms are actually from BPH, measure your prostate, assess how well your bladder empties, and check your kidney function before PAE is considered. Learn more about enlarged prostate.
What Happens
What to Expect
Before the Procedure
You'll have a full BPH evaluation including symptom scoring, PSA, urine testing, and assessment of your prostate. Imaging — usually CT or MRI — maps your pelvic arteries in advance, since prostatic artery anatomy varies considerably between men. Blood work checks your kidney function. You'll be told which medications to hold and given fasting instructions, and you'll need someone to drive you home.
The Day of the Procedure
PAE typically takes one to three hours depending on your anatomy. You'll receive local anesthetic at the puncture site and sedation to keep you comfortable, but you'll remain awake. A small puncture is made in the wrist or upper thigh — no stitches are needed — and the catheter is guided to the prostatic arteries on each side in turn. Imaging confirms the position before the spheres are released.
Immediately After
You'll rest for a few hours while the puncture site seals. Most men go home the same day. Some feel pelvic pressure or discomfort as the treated tissue responds.
The First Week
Expect some pelvic or perineal discomfort, urinary frequency and urgency, and possibly blood in the urine or semen. This is the body responding to the treated tissue and it settles over days. Take it easy, avoid heavy lifting, and follow your team's instructions on the puncture site.
Weeks Two Through Twelve
Symptoms improve gradually as the prostate shrinks. Many men notice a difference within two to four weeks, with continued improvement over three to six months. Unlike procedures that remove tissue directly, PAE's results build over time rather than arriving immediately.
Follow-up
We'll see you to track your symptom scores, check how well you're emptying, and confirm the treatment is working. Because PAE is newer than the established surgical options, ongoing follow-up is part of the care rather than an afterthought.
Risks & Side Effects
Side Effects
Post-PAE Syndrome
The most common experience afterward. A combination of pelvic pain, urinary frequency and urgency, nausea, and sometimes a low-grade fever, lasting days. It reflects the treated tissue responding rather than a complication, and it's managed with anti-inflammatories and fluids.
Blood in Urine, Semen, or Stool
Common in the first days to weeks. Blood in the semen can persist longer and look alarming without being dangerous.
Puncture Site Bruising or Hematoma
Bruising at the wrist or groin is common. A larger collection of blood is uncommon and usually resolves without intervention.
Non-Target Embolization
The prostatic arteries sit close to vessels supplying the bladder and rectum, and spheres travelling where they shouldn't can cause localized injury. This is uncommon, and modern imaging is designed specifically to prevent it — but it's the risk that makes operator experience matter.
Urinary Retention or Infection
Some men have temporary difficulty urinating after the procedure, occasionally needing a catheter briefly. Urinary tract infection can occur and is treated with antibiotics.
Technical Failure
In some men, the prostatic arteries can't be catheterized successfully because of anatomy or atherosclerosis, and the procedure can't be completed on one or both sides.
The Need for Further Treatment
This is the honest trade-off. PAE generally produces less improvement in urinary flow than TURP, and a greater proportion of men need another procedure in the years afterward. For many, avoiding surgery and preserving sexual function is worth that. Your urologist will give you a straight assessment of what to expect in your case.
Answers to your PAE Questions
Frequently Asked Questions
It works through the bloodstream, not the urethra.
TURP, UroLift, and Rezum all reach the prostate through the urethra, removing, repositioning, or shrinking tissue directly. PAE reduces the prostate's blood supply from within the arteries, so nothing passes through the urinary tract at all.
Usually not — that's a main advantage.
Retrograde ejaculation is common after TURP and occurs with some other treatments, but it's uncommon after PAE, and erectile function is generally preserved. This is one of the main reasons men choose it.
Weeks, not days.
The prostate shrinks gradually after its blood supply is reduced, so improvement builds over time. Many men notice a change within two to four weeks, with continued improvement over three to six months.
No — awake, with local anesthetic and sedation.
ou'll be sedated and comfortable but not under general anesthesia. Most men feel pressure rather than pain.
Usually not.
Most men go home without one, unlike several other prostate procedures. Some who arrive already in retention keep a catheter until the prostate responds.
Possibly — more often than after TURP.
PAE generally produces less flow improvement than TURP, and more men need further treatment in the years afterward. Having PAE doesn't rule out other treatments later if you need them.
Varies — check before scheduling.
Coverage differs between plans, and some require documentation that other treatments were tried first. Our staff can verify your benefits before you commit.
Want to avoid prostate surgery?
Let's talk about whether PAE fits.
We'll evaluate your symptoms and your anatomy, and give you an honest comparison of PAE against the other options — including what each one costs you as well as what it offers.
